Chua Yan Ting, Leo Cheang Han, Chua Horng Ruey, Wong Weng Kin, Chan Gek Cher, Vathsala Anantharaman, Gan Ye Lu Mavis, Teo Boon Wee
Division of Nephrology, Department of Medicine, National University Hospital, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Singapore Med J. 2025 Jun 1;66(6):301-306. doi: 10.4103/singaporemedj.SMJ-2022-193. Epub 2023 Aug 14.
The profile of patients referred from primary to tertiary nephrology care is unclear. Ethnic Malay patients have the highest incidence and prevalence of kidney failure in Singapore. We hypothesised that there is a Malay predominance among patients referred to nephrology due to a higher burden of metabolic disease in this ethnic group.
This is a retrospective observational cohort study. From 2014 to 2018, a coordinator and physician triaged patients referred from primary care, and determined co-management and assignment to nephrology clinics. Key disease parameters were collated on triage and analysed.
A total of 6,017 patients were studied. The mean age of patients was 64 ± 16 years. They comprised 57% men; 67% were Chinese and 22% were Malay. The proportion of Malay patients is higher than the proportion of Malays in the general population (13.4%) and they were more likely than other ethnicities to have ≥3 comorbidities, including diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease and stroke (70% vs. 57%, P < 0.001). Malay and Indian patients had poorer control of diabetes mellitus compared to other ethnicities (glycated haemoglobin 7.8% vs. 7.4%, P < 0.001). Higher proportion of Malay patients compared to other ethnicities had worse kidney function with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 on presentation (28% vs. 24%, P = 0.003). More ethnic Malay, Indian and younger patients missed appointments.
A disproportionately large number of Malay patients are referred for kidney disease. These patients have higher metabolic disease burden, tend to miss appointments and are referred at lower eGFR. Reasons underpinning these associations should be identified to facilitate efforts for targeting this at-risk population, ensuring kidney health for all.
从基层医疗转诊至三级肾脏病护理的患者情况尚不清楚。在新加坡，马来族患者的肾衰竭发病率和患病率最高。我们推测，由于该族群代谢性疾病负担较高，转诊至肾脏病科的患者中马来族占主导。
这是一项回顾性观察队列研究。2014年至2018年期间，一名协调员和医生对基层医疗转诊的患者进行分类，并确定共同管理方式及分配至肾脏病诊所。在分类时整理关键疾病参数并进行分析。
共研究了6017名患者。患者的平均年龄为64±16岁。其中男性占57%；67%为华裔，22%为马来裔。马来族患者的比例高于其在总人口中的比例（13.4%），且与其他种族相比，他们更有可能患有≥3种合并症，包括糖尿病、高血压、高脂血症、冠状动脉疾病和中风（70%对57%，P<0.001）。与其他种族相比，马来族和印度族患者的糖尿病控制较差（糖化血红蛋白7.8%对7.4%，P<0.001）。与其他种族相比，马来族患者中肾功能较差（估算肾小球滤过率[eGFR]<30 mL/min/1.73 m²）的比例更高（28%对24%，P = 0.003）。更多的马来族、印度族和年轻患者错过预约。
转诊至肾脏病科的马来族患者数量过多。这些患者的代谢性疾病负担更高，往往错过预约，且转诊时eGFR较低。应确定这些关联背后的原因，以便针对这一高危人群采取措施，确保所有人的肾脏健康。
